Folic Acid During Pregnancy for Women Taking Antiepileptic Drugs May Improve Language Development for Their Children
A study published in Neurology evaluated the relationship between language delays in children born to women taking antiepileptic drugs (AEDs) with and without folic acid supplementation. The study was carried out in Norway, where foods are not governmentally required to contain folic acid. The positive effect of folic acid supplement use on language delay in AED-exposed children was significant only when supplement was used in the period from 4 weeks before the pregnancy and until the end of the first trimester.
At age 18 months, children born to mothers who took AEDs but not folic acid had twice the rate of language delays (34%) as children born to mothers who took AEDs and folic acid (17%). The rate of language delays in children born to mothers without epilepsy was 11%. At age 3, 24% of the children born to mothers who took AEDs and not folic acid had language delays, compared to 6% of children born to mothers without epilepsy.
For children born to mothers who took AEDs but not folic acid, the fully adjusted odds ratio for having language delays was 3.9 (95% confidence interval [CI] 1.9-7.8, P < .001) at 18 months and 4.7 at 36 months (95% CI 2.0–10.6, P < .001) compared to children born to mothers without epilepsy. For children born to mothers who took AEDs and folic acid, the odds ratio for language delays dropped to 1.7 at both 18 months (95% CI 1.2–2.6, P = .01) and at 36 months (95% CI 0.9–3.2, P = 0.13) compared to children born to mothers without epilepsy.
Medical history including material AED and folic acid use during pregnancy and children’s language development was collected from parent-completed questionnaires. The survey included 335 children born to mothers who were taking AEDs and 104,222 children born to mothers without epilepsy, all enrolled in the 299-2008 Norwegian Mother and Child Cohort Study.
“These results are important for women with epilepsy all over the world because many epilepsy drugs interact with the way folate is metabolized by the body, so we are still learning how much folic acid is needed for women with epilepsy and how it benefits their children,” said study author Elisabeth Synnøve Nilsen Husebye, MD, of the University of Bergen in Bergen, Norway.
Husebye also noted that maternal intake of folic acid earlier in pregnancy (4 weeks before conception through the first trimester) correlated with lower rates of language delays in children of mothers taking AEDs.